​The U.S. Food and Drug Administration (FDA)-approved bronchial valve placement devices, Zephyr^® or Spiration^® Valve System, will be covered effective April 1, 2022. Coverage applies to AmeriHealth members for the treatment of severe emphysema when ALL of the following criteria are met:

• Dyspneic symptoms are poorly controlled or activities of daily living are markedly restricted despite maximal medical management
• Individual has completed a pulmonary rehabilitation program prior to valve placement
• 40 to 75 years of age
• Body mass index (BMI) is less than 35kg/m2
• Stable with ≤20mg prednisone (or equivalent) daily
• Forced expiratory volume (FEV1) between 15% and 45% of predicted value at initial evaluation
• Six-minute walking distance (6MWD) ≥100m and <500m
• There is little to no interlobar collateral ventilation as determined using the Chartis^® (Zephyr) or SeleCT^® (Spiration) systems
• ​Abstinence from cigarette smoking for 4 consecutive months prior to initial evaluation, and throughout the evaluation for the procedure.

Humanitarian device exemption